City vs. Town

[mediccjh]

Start in the big city. Then you can become a sarcastic cynical wiseass like me.

In all seriousness, you will do more in the city in 1 week than you will rural in 1 month.

And Boston's EMS system is better than NYC's. That's probably the only thing Boston has better.

[itku2er]

thanks for those who helped me out (I'm gong to keep up on them, just hopefully they don't get pissed). I have another question too, I was wondering, for someone new to EMS, which route is better: To work in the city (my case Boston) or in a smaller town? (although its weird because Weymouth is considered a city, but its more like a town) I want to so badly work in Boston, but there are people who tell me "wait until you get more experience" and then there are people who tell me "that's how you get your experience". But I think its time to ask the real professionals. How do you feel about that and what was your experience? Haha i also hear that city EMS really dislike young newbies...

thanks.

-john

I have never done EMS in the City but these guys that have know how it is ...I am in a rural area and I would say that it is kinda boring here....the NH calls and transports.....the occassional MVC sometimes they are good ones with alot of trauma and really cool injuries...the Friday night GOOD OLE BOY fights....when they are drunk.....the OD'S......the MI's and Strokes...so IF you want action Go to the CITY....

But it is your choice......either way .......I hope you enjoy your EMS career and Best of luck to you in this

my 2 cents worth...And YES I am mean to the NEWBIES..... :twisted: .......if you can survive ITK you can survive EMS

Terri :angel13:

[Ridryder 911]

It all depends upon your intentions. If you intend to do this for some time and really administer patient care with detailed care, I suggest more rural settings. If you want volume, I suggest a large metro area.

I disagree with starting out in large cities. I suggest rural for learning medical care and then work city for increased skills levels. Most I have seen come to rural areas are used to high call volume but very little treatment modalities. Having a drug box with 40 -50 med's, is very unexpected, as well as spending maybe an hour or two with one patient. The other point, so many city medics presume because they have a higher call volume they perform better care and have a better EMS. This is usually far from what I have seen. In fact most flight services I have worked with preferred an urban setting, because f the diverse care the Paramedic performed, as well as continuous treatment.

Both areas have their weaknesses and strengths. Again, one needs to weigh what their goals are.

Good luck,

R/r 911

[PRPGfirerescuetech]

Exactly.

Rural is the ideal builder of the pre hospital clinician. Urban makes that clinician shine. Start rural, and build your way up.

Then, get older than dirt like Rid and Dust, and go back to the slower, rural houses :)

[AZCEP]

I will respectfully disagree with you Rid.

When starting out, the major hurdle that I've seen is a lack of ability to assess the situation when you walk into a scene. The call volume of urban systems helps to eliminate this shortcoming. 10-15 calls a day forces you to develop a style more quickly than 3-5 calls will.

I do agree, however, that the longer transport/scene times that happen in the rural systems is very beneficial to figuring out how second and third line treatments work. With short transport times, you just don't get to see what your treatment actually does.

Possibly the best situation would be a somewhat suburban setting. More calls than rural, longer transport times than urban, and just enough variety to get exposure to more situations.

Then again, everyone has a different learning curve.

[Dustdevil]

That is pretty much where I am coming from too, AZ.

I fully agree with Rid and PRPG that rural is where you will really hone your skills and become a good medical provider. However, the number one most difficult and important skill you have is patient assessment. Regardless of how long you ultimately spend caring for your patient, the assessment is the same. It is not better learned in either the rural or urban environment. The only thing that contributes to the development of your assessment skills is volume. The more patients of the more variety you see, the more patients and conditions you will assess. Consequently, you will become a better clinician faster in most urban environments simply due to volume and variety.

I am certainly not saying that urban experience is better experience. In fact, as Rid said, it is not. But again, volume and variety are the keys to developing your assessment skills. And until your assessment skills are developed, I don't care how many IV's you've started or how many tubes you've dropped, you are not yet a competent medic.

[Ridryder 911]

I agree with the exposure. From most of my experience and observation of larger services there is so much "cookie cutter" type medics, with emphasis on policies and protocols rather than individual assessments, and techniques. So much pressure is placed o "following it their way as well as scene time, etc. very little is autonomy and individualism is sometimes discouraged.

Yes, the volume will definitely "hone" your skills as well as get bored, after a while. That is why I suggested part time, hopefully at a urban area, one can provide more autonomous care, and focus those associated skills at the larger service. I suggest the same in nursing.

Be safe,

R/r 911

[Nate]

As far as the issue with running calls that don't amount to much in the city, I'd like to offer a different look. That depends on the city, and the area that you work in. I work for two services in two different cities that are divided by a street and some rail road tracks. The call volumes on the two sides are very different, and the types of calls are as well.

In one city we have no freeways, so our MVA's are usually minor, and involve objects such as telephone poles, the ditch, or a building. For the most part, we are able to get them out with very little effort and their injuries are usually minor. However, the stabbings, GSW's, and other forms of trauma are very high. Our medical calls are usually the real thing because the people of this area are mostly hispanic and a good portion of them are illegal. They prefer to avoid any city employee at all costs and will only call if they need us. Now I'm not saying that all I do is paramedic calls, but a good portion of them are.

In the other city, which is larger, we have two major freeways (and several miles of them), then several city roads that have high speed limits, so that is were I get most of my entrapment calls. Also, since the population is more mixed, we see a wide range of EMS abuse, crack heads, and other calls that don't really amount to much. I'd say that about two thirds of a our calls here aren't anything major, and the rest are (which is more similar to most city break downs).

Another thing to focus on is this observation. When I worked on a "nicer" side of town our MVA's didn't really see that many injuries because of the air bags, quality of build in the new cars, etc. Down here we have a lot of people still driving all steel cars with lap belts. I'm not saying that Volvos, BMW's, and other nicer cars mean you won't see injuries, you'll just see more with these older cars that lack the safty features of today's cars.

I think you should go where YOU want to go and just focus on being the best medic that you can. You should do your best (I know it is hard) to avoid the BS that negative people seem to find, and focus on the ones who still love this line of work. The first thing I tell new hires with little to no time under their belts is this: "I've been where you are, and we will never know all of the answers. Do your best, admit when you don't know, and remember that you should enjoy this job."

[steve-in-kville]

Having been through this situation of rural vs. city, I shall add my two cents.

I was volunteer with a small town service that maybe ran 120 calls per year. When I moved, the volly service there ran about 350 to 400 (sometimes more) calls per year. I went to work for our nearest city EMS and was catapluted from a single-truck service to a paid service with a dozen trucks running 911 calls plus a few that did transports and wheelchair runs. I went from writing 30-50 calls a year to 5 or more per 8-hour shift.

Lets just say I learned more in one year than I did the previous 8 years as a volly!!

steve